Getting serious about preventable deaths and injuries behind bars

The plight of children and their families in ICE detention centers has again caused a brief moment of focus on conditions of detention.

Unfortunately, there is little happening to provide transparency about the ways in which detention in jail, prison or ICE facilities harms health. Until we get serious about tracking and reporting deaths, injuries and other health outcomes that occur in these 5,000 paramilitary settings we will fail to address the large number of these preventable incidents that occur in or are directly caused by the detention setting. 

Every year about 5,000 people die behind bars in the U.S. I estimate that between 15 percent and 30 percent of these deaths are attributable to errors or abuse by security or health services. I believe this because I was the chief medical officer at Rikers Island. In my nine years there and three years since investigating deaths in jails and prisons across the U.S., I’ve come to understand that many deaths are jail-attributable.

In fact, these settings are designed and administered to confer health risks to incarcerated people. These health risks include death, injury and sexual abuse. Many who die commit suicide, which is the leading cause of death in America’s county jails. The use of solitary confinement, whether in name or practice, as the primary response to mental health and substance use issues behind bars is an important contributor to these preventable deaths. Other drivers of preventable death include denial of care for chronic disease, lack of treatment for substance use and outright physical abuse.

Injury is very common behind bars, often as a result of violence, but we lack any national strategy to even understand injury incidence behind bars let alone prevent it. There are also gross disparities in these health risks, so that critical decisions about whether a person will receive abuse or health treatment behind bars behind bars are often impacted by their race, age or LGBTQ status.

If we seek any confidence that these horrors will abate, we need to get serious about recording and preventing these grave health outcomes just as we do in hospitals, schools, nursing homes and other public institutions.

Standardized reporting and prevention of injuries, deaths and other markers of abuse among incarcerated persons cannot be voluntary. It may seem very basic, but the organizations that measure and promote health in the rest of our nation must stop ignoring the plight of the incarcerated. These groups include the Centers for Disease Control at the federal level, state departments of health and county health departments.

Despite ample and well-deserved attention to ICE detention settings, I have yet to hear any of the Democratic candidates for president discuss how they would bring the nation’s substantial public health infrastructure to bear in preventing death and injury behind bars.

Beware the false choice between undoing mass incarceration and improving conditions for the incarcerated. We can and must do both. Even if we cut our national rate of incarceration in half, we will still have six million incarcerations per year.

My experience in New York City was that while the city achieved amazing success in reducing jail census from 22,000 to under 8,000 today, there was little done to stem the culture of abuse and violence experienced by the people who were held there.

If we are to enact lasting justice reform, we need to be honest and accountable about the ways in which incarceration harms health.

Dr. Homer Venters is the senior health and justice fellow for Community Oriented Correctional Health Services and author of “Life and Death in Rikers Island.”